Evaluation of high-dose continuous nebulized levalbuterol

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In this issue of The Journal, Andrews et al from the University of Pennsylvania compared high-dose continuous levalbuterol to high-dose continuous racemic albuterol using equipotent doses in 81 children attending the emergency department with acute exacerbations of asthma. The adverse effects and the outcomes were similar in the two groups. Both groups were weaned from continuous bronchodilator therapy in 16-18 hours but no advantage was demonstrated for levalbuterol. It is notable that there was pharmaceutical company support for this study, although in the end the results did not benefit the company.

These findings are discussed in an accompanying editorial by Kercsmar, who reviews the current management of acute asthma in the emergency room with regards to the use of short acting β-agonists and continuous aerosol therapy. Although Kercsmar expresses some reservations concerning the study design, the results certainly do not support the use of levalbuterol in the emergency room, especially as it is significantly more expensive than the racemic mixture. Kercsmar goes on to discuss the question of whether there are some asthmatics for whom no form of albuterol is effective; recent trials have suggested that certain polymorphisms of the beta receptor respond poorly to albuterol. Future studies should clarify this issue.

Article page 205▸

Editorial page 162▸